SVT with Aberrancy

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Transcutaneous PacingStep-by-step setup, capture & troubleshooting
TC Pacing — Quick Steps
Full guide →
  1. Apply pads anterior–posterior; attach ECG leads from the pacer/monitor.
  2. Pre-medicate for discomfort: midazolam ± fentanyl if BP allows.
  3. Set mode Demand (synchronous), rate 60–80/min.
  4. Increase output (mA) by 5–10 until electrical capture (wide QRS after each spike).
  5. Confirm mechanical capture: palpate femoral/right brachial pulse (not carotid).
  6. Set final output ~10 mA above threshold; reassess BP, perfusion, mentation.
  7. Bridge to transvenous pacing or treat underlying cause.
ANTERIORANTPOSTERIORPOSTSandwich the heart between pads
A–P pad placement

Rhythm strip

Source ↗
Wide QRSRegular & fastUniform BBB morphology
Schematic placeholder — tap labels to highlight key features.

Tap a label on the strip to highlight the matching feature below.

  • Wide QRS tachycardia
  • Regular and fast
  • Uniform BBB morphology — matches prior baseline ECG
Recognition
  • Regular, wide QRS tachycardia
  • QRS morphology matches a typical RBBB or LBBB pattern
  • May have prior ECG showing same BBB at slower rates
  • Brugada / Vereckei criteria help distinguish from VT
Management
When in doubt — treat as VT
  • 20–50 mg/min (max 17 mg/kg) is safe for both VT and SVT with aberrancy.
If clearly SVT with aberrancy
  • : vagal → adenosine → AV nodal blockade
  • (WPW)

Educational reference only. Always follow current ACLS guidelines and institutional protocols.